Healthcare Provider Details

I. General information

NPI: 1144927914
Provider Name (Legal Business Name): HEATHER RENEE GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLEGE ST STE D
SOMERSET KY
42501-1307
US

IV. Provider business mailing address

105 COLLEGE ST STE D
SOMERSET KY
42501-1307
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-2636
  • Fax:
Mailing address:
  • Phone: 606-677-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number304229
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: